Attachments G and H - LFUTS

Form Approved

OMB No. 0920-XXXX

Exp. Date xx/xx/20xx

Attachment G: Live Follow-up Telephone Survey (English) (referred to in the 30 Day Federal Register Notice as the Follow Up Survey)

Live Follow-Up Telephone Survey

INTRODUCTION

Hello! A few weeks ago someone in your household agreed to take part in a 7 minute survey. Are you that person?

If the person answering the telephone is not the person who agreed to participate in the survey, reply:

When would be a good time to reach the person who agreed to participate in the survey?

If the person answering the telephone says he or she is the person who agreed to participate in the survey, reply:

In order to verify your identity, we gave you a code word for you to remember. What is that code word?

[The code word is CDC-INFO. If can’t recall] Do you remember the name of the organization that asked you to participate in a survey?

[If not handy] Are you able to get it? We can only proceed with the survey if we can verify your identity with the code word.

[If not available] I’m sorry, but you need to have the code word to participate. Thank you for your interest in the survey. Goodbye.

[If yes] Great! You can skip any question you don’t want to answer or stop at any time.  If you’re ready, let’s begin.

[If not available now] When is a good time for me to call you back?

[If yes]

• Remember, we are definitely not selling anything.

• Your responses will be strictly confidential and will not be identified with you in any way.

• This survey is being conducted by E.M.T. Associates, Inc., an independent research firm. We are contracted by CDC-INFO to conduct this independent survey.

[Note: If the respondent asks for more information about CDC-INFO, reply]

CDC-INFO is a single phone number for the public to access information on a variety of health topics. CDC –INFO is funded by the Centers for Disease Control and Prevention. If you have any questions about the survey, you may contact the study director, Dr. Elizabeth Harris at (800) 368-0056 (800-EMT-0056).

Public reporting burden of this collection of information is estimated to average of 7 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-XXXX)

QUESTIONS

Familiarity with CDC INFO

1. Was that the first time you contacted CDC-INFO?

1.	Yes
2.	No
3.	Refused to answer

2 How did you find out about CDC-INFO? [Check all that apply]

1. Advertisement on TV or Radio
2.	TV ad
3.	Radio ad
4. Advertisement NOT on TV or Radio
5.	Billboard
6.	Bus ad (outside or inside)
7.	Flyer
8. School
9.	Preschool
10.	Elementary School
11.	Middle School
12.	High School
13.	College
14. Health care provider
15.	Hospital
16.	Doctor/other health care professional
17.	Other health care hotline
18.	Social Worker
19. Media
20.	Phone book or Information line (411)
21.	Internet search
22.	Other web site
23.	CDC-INFO Website
24.	Story line on TV program
25.	Newspaper story
26.	Radio announcement or news story
27.	TV announcement or news story
28.	Friend/family member
29.	Other: ____________________
30.	Don’t recall
31.	Refused to answer

Usefulness of CDC-INFO

3. Was it easy to actually reach a representative?

1.	Yes
2.	No
3.	Refused to answer

[If the respondent does not answer question 3 as “Yes,” probe]

4. I would appreciate it if you could tell me more about the difficulties you experienced in reaching a representative.

1.	Confused about what selection to choose
2.	Took too long to get through automated system
3.	Put on hold for a long time
4.	Other (specify) _________________
5.	Refused to answer

Knowledge Change

5. What did you learn from your call to CDC-INFO that you did not know before?

1.	Nothing [skip to Q9]
2.	Where to get additional information
3.	The need for testing
4.	Where to go for testing
5.	Need to seek medical attention
6.	Symptoms of disease
7.	Risk reduction/prevention strategies
8.	Immunization schedule
9.	Other (specify) _________________
10.	Refused to answer

Attitude Change

6. Did what you learned make you want to change any behaviors?

1.	Yes
2.	No [skip to Q9]
3.	Not sure
4.	N/A [what caller learned was not related to behavior]
5.	Refused to answer

7. [If “yes” or “not sure” to above] I would appreciate it if you would tell me more about what changes you are thinking about. Would you feel comfortable sharing that with me? If not, we can go to the next question. [Mark all that apply]

1.	Increase physical activity
2.	Lose weight
3.	Change diet or eating habits
4.	Quit smoking / reduce amount smoked or reduce tobacco use (smokeless tobacco)
5.	Exercise better hygiene
6.	Get counseling
7.	Start taking medications
8.	Plan to see a doctor
9.	Reduce risky sexual behaviors
10.	Get tested
11.	Change eating habits
12.	Get immunized
13.	Other: (specify)________________________
14.	Refused to answer

Behavior Change

8. Have you actually changed any behaviors?

1.	Yes
2.	No
3.	Not yet, but planning to
4.	Refused to answer

Comfort with the CSR/HSR

[Note to interviewer: If the respondent talked with more than one representative and is unsure which one to comment on, tell the respondent: “Please choose the representative you want to talk about most.”]

9. Thinking about the person you spoke with at CDC-INFO, how polite was the representative? [Read options to respondent]

1.	Very polite
2.	Somewhat polite
3.	Not very polite
4.	Not at all polite
5.	Refused to answer

10. How satisfied are you with the way he or she interacted with you during the call? [Read options to respondent]

1.	Very satisfied
2.	Somewhat satisfied
3.	Somewhat dissatisfied
4.	Very dissatisfied
5.	Refused to answer

Trust in CDC INFO

11. How knowledgeable was the person you spoke with? [Read options to respondent]

1.	Very knowledgeable
2.	Somewhat knowledgeable
3.	Not sure
4.	Not very knowledgeable
5.	Not knowledgeable at all
6.	Refused to answer

12. How helpful was the person you spoke with at CDC-INFO? [Read options to respondent]

1.	Very helpful
2.	Somewhat helpful
3.	Not very helpful
4.	Not at all helpful
5.	Refused to answer

13. Overall, how satisfied are you with the quality of the health information provided by CDC INFO? [Read options to respondent]

1.	Very satisfied
2.	Somewhat satisfied
3.	Neither
4.	Somewhat dissatisfied
5.	Very dissatisfied
6.	Refused to answer

14. Do you consider CDC-INFO to be a reliable source of information? [Read options to respondent]

1.	Definitely yes
2.	Probably yes
3.	Don’t know/not sure
4.	Probably not
5.	Definitely not
6.	Refused to answer

Overall Satisfaction with CDC-INFO

15. Thinking about your entire call experience, how satisfied are you with CDC-INFO? Are you: [Read options to respondent]

1.	Very satisfied
2.	Somewhat satisfied
3.	Neither
4.	Somewhat dissatisfied
5.	Very dissatisfied
6.	Refused to answer

17. [If less than “very satisfied” to above] I would appreciate it if you would tell me about the reason you are not completely satisfied. [Mark all that apply]

System Issues			Publication Issues
	Hard to reach a live operator		21.	No publication available
	On hold too long		22.	CSR would not take publication order
	No one spoke language		Other
	Poor telephone connection		34.	Doesn’t want to report satisfaction until services are received
CSR Issues			35.	Lost information from CDC-INFO
	Call took too long		36.	Other (specify):
	CSR couldn’t find answer to question		37.	Refused to answer
	CSR wouldn’t answer question
	CSR didn’t understand what I needed
	CSR referred respondent to another hotline
	CSR hard to understand (didn’t speak clearly)
	CSR was disrespectful/rude
	CSR was impatient
	Not enough information provided (partial answer to question)
	Unclear information provided
	Too much information provided
	Information was too technical to understand
	Information not relevant to question
	Information not current/most recent
	Sent to website
	Could’ve looked up same information on website

18. Judging from your experience with CDC-INFO, would you call again?

1.	Yes
2.	No
3.	Refused to answer

19. Would you recommend CDC-INFO?

1.	Yes
2.	No
3.	Refused to answer

20. Have you recommended CDC-INFO?

1.	Yes
2.	No
3.	Refused to answer

21. Who would you have called if CDC-INFO was not available? [Check all that apply]

1.	Doctor’s office
2.	Don’t know
3.	Community health center
4.	Walk-in clinic
5.	Telephone health line (specify)___________________
6.	Hospital emergency room
7.	Other hospital service
8.	Other: (specify) ___________________
9.	Refused to answer

Thank you very much! Do you have any questions for me in regard to this survey?

CDC-INFO can be reached at 1-888-CDC-INFO, 1-888-232-4636. Thanks again!

* [Note to Interviewer: Please write any general comments that are NOT improvement related. Include positive comments here.]

Attachment H: Live Follow-up Telephone Survey (Spanish) (referred to in the 30 Day Federal Register Notice as the Follow Up Survey)

Live Follow-Up Telephone Survey

Introduction

Hola! Hace unas semanas alguien en su hogar estuvo de acuerdo en participar en un cuestionario de 7 minutos de duración. Es Ud. esa persona?

If the person answering the telephone is not the person who agreed to participate in the survey, reply:

Cual sería la mejor hora para encontrar a la persona que estuvo de acuerdo en participar en el questionario?

If the person answering the telephone says they are the person who agreed to participate in the survey, reply:

Con el fin de verificar su identidad se le dió una clave la cual se le pidió recordar. Podría darme la clave?

[The code word is CDC-INFO. If can’t recall] Se acuerda del nombre de la organización que le pidió participar en el cuestionario?

[If not handy] Sería mucha molestia pedirle que buscara la clave? Solo podemos proceder con el questionario después de que su identidad haya sido verificada con la clave.

[If not available] Lo siento, pero necesita tener la clave par poder participar. De todas maneras gracias por su interés en el cuestionario. Adiós.

[If yes] Magnífico! Ud. puede omitir cualquier pregunta que no desee responder o terminar este questionario en cualquier momento. Si esta listo, empecemos!.

[If not available now] Cuando sería el mejor momento para volverlo a llamar?

[If yes]

• Dejeme recordarle que definitivamente no le estamos vendiendo nada.

• Sus respuestas seran estrictamente confidenciales y no seran relacionadas con usted de ninguna manera.

• Este cuestionario esta siendo conducido por E.M.T. Associates, Inc. Una agencia independiente de investigaciones. Nosotros hemos sido contratados por CDC-INFO para llevar a cabo este cuestionario.

De acuerdo a gravámenes en informes públicos el promedio para recaudar ésta información es de 7 minutos por respuesta, lo cual incluye el tiempo utilizado para revisar instrucciones, buscar fuentes de datos ya existentes, recaudar y conservar datos necesarios, y completar y analizar la recaudación de la información. Una recaudación de información no debe llevarse a cabo o ser auspiciada por una agencia al menos que dicha recaudación lleve consigo un número actual de control OMB válido. De igual modo una persona no debe responder una recaudación de información si dicha recaudación no presenta un número actual de control OMB válido. Por favor sírvase enviar comentarios con respecto al estimado de este gravamen o de cualquier otro aspecto de ésta recaudación de información, también se pueden incluir sugerencias en cómo reducir este gravamen a CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74 Atlanta, Georgia 30333. ATTN: PRA (0920-XXXX)

[Note: If the respondent asks for more information about CDC-INFO, reply]

CDC-INFO es un número telefónico individual para uso del público y brinda acceso a información sobre diversos temas de salud.  CDC-INFO es financiado por el Centro para el control y prevención de enfermedades. Si tiene alguna pregunta acerca del cuestionario. Ud puede comunicarse con  la directora de este estudio, Doctora Elizabeth Harris al (800) 368-0056 (800-EMT-0056).

PREGUNTAS

Familiaridad con CDC-INFO

1. Fue la primera vez que llamó a CDC-INFO?

1.	Yes
2.	No
3.	Refused to answer

2. Cómo se enteró de CDC-INFO? [Check all that apply]

1. Advertisement on TV or Radio
2.	TV ad
3.	Radio ad
4. Advertisement NOT on TV or Radio
5.	Billboard
6.	Bus ad (outside or inside)
7.	Flyer
8. School
9.	Preschool
10.	Elementary School
11.	Middle School
12.	High School
13.	College
14. Health care provider
15.	Hospital
16.	Doctor/other health care professional
17.	Other health care hotline
18.	Social Worker
19. Media
20.	Phone book or Information line (411)
21.	Internet search
22.	Other web site
23.	CDC-INFO Website
24.	Story line on TV program
25.	Newspaper story
26.	Radio announcement or news story
27.	TV announcement or news story
28.	Friend/family member
29.	Other: ____________________
30.	Don’t recall
31.	Refused to answer

Utilidad de CDC- INFO

3. Fue fácil lograr hablar con un representante?

1.	Yes
2.	No
3.	Refused to answer

4. Apreciaría mucho si me dijera las dificultades que experimentó al tratar de hablar con un representante.

1.	Confused about what selection to choose
2.	Took too long to get through automated system
3.	Put on hold for a long time
4.	Other (specify) _________________
5.	Refused to answer

Cambio en conocimiento

5. Aprendio algo nuevo como resultado de su llamada a CDC-INFO?

[Probe: Obtuvo información que usted no sabia durante su llamada?

1.	Nothing [skip to Q9]
2.	Where to get additional information
3.	The need for testing
4.	Where to go for testing
5.	Need to seek medical attention
6.	Symptoms of disease
7.	Risk reduction/prevention strategies
8.	Immunization schedule
9.	Other (specify) _________________
10.	Refused to answer

Cambio de actitud

6. Cambio algo en su conducta/comportamiento como resultado de esta nueva información?

La nueva información hizo que cambiara algo en su comportamiento/conducta?

1.	Yes
2.	No [skip to Q9]
3.	Not sure
4.	N/A [what caller learned was not related to behavior]
5.	Refused to answer

7. [If “yes” or “not sure” to above] Apreciaría mucho si me dijera que cambios esta pensando hacer. Pero si no se siente cómodo compartiendo esta información con nosotros, podemos continuar con la siguiente pregunta. [Mark all that apply]

1.	Increase physical activity
2.	Lose weight
3.	Change diet or eating habits
4.	Quit smoking / reduce amount smoked or reduce tobacco use (smokeless tobacco)
5.	Exercise better hygiene
6.	Get counseling
7.	Start taking medications
8.	Plan to see a doctor
9.	Reduce risky sexual behaviors
10.	Get tested
11.	Change eating habits
12.	Get immunized
13.	Other: (specify)________________________
14.	Refused to answer

8. Ya hizo algun cambiado en su comportamiento/conducta?

1.	Yes
2.	No
3.	Not yet, but planning to
4.	Refused to answer

Conformidad con el CSR/HSR

[Note to interviewer: If the respondent talked with more than one representative and is unsure which one to comment on, tell the respondent: “Por favor escoga el representante del cual quiere hablar más.”]

9. Por favor piense en la persona con la que habló en su llamada a CDC-INFO, Que tan cortez fue el representante? [Read options to respondent] Diria usted:

1.	Muy cortez
2.	Algo cortez
3.	No fue muy cortez
4.	Descortez
5.	Rehuso a contestar

10. Que tan satisfecho esta con la manera que el representante interactuó con usted durante la llamada? [Probe: Esta usted satisfecho con la manera en que usted fue tratado] [Read options to respondent] Diria usted:

1.	Muy satisfecho
2.	Algo satisfecho
3.	Algo insatisfecho
4.	Muy insatisfecho
5.	Rehuso a contestar

11. Tuvo la persona con quien habló un buen conocimiento sobre la informacion que usted pidió? ? [Probe: Diria que la persona mostro familiariad con la información. Hablaba la persona con seguridad?]

Que tan instruida o experta era la persona con quien habló [Read options to respondent] Diria que la persona fue:

1.	Muy instruida
2.	Algo instruida
3.	No se
4.	No muy instruida
5.	Inculta
6.	Rehuso a contestar

12. Que tan servicial fue la persona con quien habló en CDC-INFO? [Read options to respondent] Diria que la persona fue:

1.	Muy servicial
2.	Algo servicial
3.	No muy servicial
4.	Desagradable
5.	Rehuso a contestar

13. En general, que tan satisfecho esta con la calidad de la información sobre salud que CDC-INFO le brindó? [Read options to respondent] Diria que la persona fue:

1.	Muy satisfecho
2.	Algo satisfecho
3.	Ninguno
4.	Algo insatisfecho
5.	Muy insatisfecho
6.	Rehuso a contestar

14. Considera usted a CDC-INFO como un recurso de información en el cual puede confiar? [Read options to respondent] Diria usted:

1.	Definitivamente si
2.	Probablemente si
3.	No se/No estoy seguro
4.	Probablemente no
5.	Definitivamente no
6.	Rehuso a contestar

15. Por favor piense en su llamada en general. Que tan satisfecho esta con CDC-INFO? [Read options to respondent] Diria usted:

1.	Muy satisfecho
2.	Algo satisfecho
3.	Ninguno
4.	Algo insatisfecho
5.	Muy insatisfecho
6.	Rehuso a contestar

16. [If less than “very satisfied” to above] Apreciaría mucho si me dijera la razón de su insatisfacción. [Mark all that apply]

System Issues			Publication Issues
	Hard to reach a live operator			No publication available
	On hold too long			CSR would not take publication order
	No one spoke language		Other
	Poor telephone connection			Doesn’t want to report satisfaction until services are received
CSR Issues				Lost information from CDC-INFO
	Call took too long			Other (specify):
	CSR couldn’t find answer to question			Refused to answer
	CSR wouldn’t answer question
	CSR didn’t understand what I needed
	CSR referred respondent to another hotline
	CSR hard to understand (didn’t speak clearly)
	CSR was disrespectful/rude
	CSR was impatient
	Not enough information provided (partial answer to question)
	Unclear information provided
	Too much information provided
	Information was too technical to understand
	Information not relevant to question
	Information not current/most recent
	Sent to website
	Could’ve looked up same information on website

17. A juzgar por su experiencia con CDC-INFO, llamaría otra vez?

1.	Yes
2.	No
3.	Refused to answer

17. Recomendaria CDC-INFO?

1.	Yes
2.	No
3.	Refused to answer

17. Ya ha recomendado a CDC-INFO?

1.	Yes
2.	No
3.	Refused to answer

17. A quién hubiese llamado si CDC-INFO no estuviera disponible? [Check all that apply]

1.	Doctor’s office
2.	Don’t know
3.	Community health center
4.	Walk-in clinic
5.	Telephone health line (specify)___________________
6.	Hospital emergency room
7.	Other hospital service
8.	Other: (specify) ___________________
9.	Refused to answer

Muchas gracias! Tiene usted alguna pregunta con respecto a este cuestionario?

Para comunicarse con CDC-INFO llame al 1-800-CDC-INFO, 1-800-232-4636. Nuevamente, muchas gracias!